New technology makes heart disease treatment less invasive

Heart disease is the No. 1 killer of both men and women, but new treatments to battle the condition are continually being developed.

Heart disease is a broad term used to describe a range of conditions that affect the heart, including diseases of the blood vessels, such as coronary artery disease; heart rhythm problems; heart infections; and congenital heart defects.

To get an idea of how common the disease is, Dr. Mehran Moussavian, a board certified cardiologist and director of the cardiac catheterization lab at Sharp Chula Vista Medical Center, said more women nationwide have heart disease than all cancers combined — including breast cancer.

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Heart disease kills more than 600,000 Americans annually, and in San Diego County, approximately 300 people out of every 100,000 people die from the disease, according to the Centers for Disease Control and Prevention.

Moussavian said heart disease accounts for the highest expenditures in the health care system, costing $60 billion per year when factoring in medications, cost of care and lost productivity.

Although any issue that affects the heart can be defined as heart disease, said Dr. Nassir Azimi, who practices interventional cardiology at Sharp Grossmont Hospital in La Mesa, the term generally refers to coronary heart disease, where a waxy substance called plaque builds up inside the arteries that supply blood to the heart. He said this can lead to a heart attack over time.

“Heart disease is a spectrum of illnesses,” Azimi said. “(But) heart attacks make up most deaths.”

Because heart disease is so prevalent, there have been advancements in recent years in both prevention and treatment, and many medical measures on the horizon are less invasive, meaning some forms of heart disease can be treated without heart surgery.

“We’re in a new era of surgical heart disease,” Moussavian said.

Dr. Kiyon Chung, chief of cardiology at Scripps Mercy Hospital in San Diego, said in general, treatments for heart disease are becoming less invasive. One treatment she said she’s excited about is transcatheter aortic valve replacement, also known as TAVR.

Chung said TAVR is used to treat patients who have narrowing of the heart valves. Instead of opening the chest to repair the valves, she said small incisions are made in the leg and a catheter is inserted through the groin and navigated through arteries to the heart.

A new valve is positioned inside the faulty valve and a small balloon on the catheter inflates and locks it into place inside the aortic valve. The replacement valve has three flaps similar to original heart valves.

While Moussavian said the procedure is still in the clinical trial phase, he expects it to get FDA approval soon.

“So far, it’s very effective and very promising,” he said.

Less-invasive devices such as defibrillators (left) and pacemakers shock the heart if the organ has a lethal rhythm.— Photos.com

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Less-invasive devices such as defibrillators (left) and pacemakers shock the heart if the organ has a lethal rhythm.
/ Photos.com

Following the trend of less-invasive devices, Chung said development is underway to make pacemakers and defibrillators — devices that shock the heart if the organ has a lethal rhythm — implanted under the skin with a smaller device fitting under the heart.

Moussavian said he also expects the FDA to approve left arterial appendage closure devices. He said among heart disease patients ages 65 and older, the leading cause of stroke is atrial fibrillation, a condition where the heart’s two small upper chambers beat irregularly and too fast.

He said those patients are typically treated with blood thinners, but a certain number of patients can’t tolerate them. For such patients, the left arterial appendage closure can be inserted and implanted through a catheter in the leg. It closes off the left atrial appendage, which is thought to be the main source of blood clots for those with atrial fibrillation.

“It’s a game-changer in cardiology,” Moussavian said.

When it comes to prevention, the American Heart Association and American College of Cardiology released new guidelines last year regarding cholesterol and heart disease that have proven to be controversial.

Chung said instead of focusing on numbers when it comes to bad cholesterol, new guidelines focus more on incorporating risk factors such as age, family history and whether a person smokes.

“We’re not just looking at one number itself,” Chung said. “We’re looking at all the factors we now know can contribute to heart disease.”

She said if those combined risk factors suggest a person has a moderate to high risk of developing heart disease within a decade, it’s recommended they begin treatment with statins, which are cholesterol-lowering medications.

In addition to the new suggestions regarding cholesterol, Chung said the American Heart Association recently released new stroke guidelines for women — the first time guidelines have been gender-specific.

For instance, she said women can have pregnancy-related complications such as high blood pressure or gestational diabetes that can create problems post-pregnancy.

Moussavian said women with heart disease tend to have different symptoms than men. He said while men typically experience chest pain, sweating, nausea and pain in their shoulders when suffering from heart problems, women’s symptoms include fatigue, insomnia and back pain. As a result, heart disease in women may not be detected until it’s more advanced.

Chung said the new guidelines can also help physicians recognize patients at risk for stroke at a much younger age.